4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
The Minister of Health and the health insurers have agreed that no health institution may go bankrupt due to the COVID-19 crisis. The exact measure and the distribution of the cost between the Ministry of Health and the health insurers is still subject to negotiation. The measure is valid from 1 March to (at this moment) 1 June (https://www.skipr.nl/nieuws/vws-bezig-met-reddingsplan-zorg-niemand-failliet/).
According to a motion accepted in Parliament, care personnel should receive a bonus. However, it is not yet clear how high this bonus should be and who is going to pay for it.
The Dutch Healthcare Authority has allowed to conduct the initial patient consultation by telephone or otherwise remotely in the case of regular care. Normally, the first contact should be face-to-face to be eligible for remuneration. As regular consultations are now shifted to telephone consultations, this is important to ensure financing of regular care. For long-term care a regulation is due (expected in June) for extra costs due to isolation and caring for COVID-19 patients (https://www.nza.nl/actueel/nieuws/2020/03/13/nza-past-regelgeving-aan-vanwege-coronavirus).
Health insurers have decided that they will compensate dentists and physical therapists for part of their loss in revenue. Healthcare providers that are not involved in coronavirus care will receive the payments, because other arrangements are in place for coronavirus. The compensation is meant for covering fixed costs. If healthcare providers manage to limit their losses later in the year, they may receive a lower compensation. The Association that represents the dental sector supports this decision. However, dental practices will also lose revenue from patients who pay for dental care themselves as they are not insured for dental care via voluntary health insurance. It is not yet clear how and whether these losses will be compensated (https://nos.nl/artikel/2329500-zorgverzekeraars-gaan-tandartsen-en-fysiotherapeuten-financieel-compenseren.html).
GPs will receive an extra compensation for coronavirus care. They will receive EUR 10 for each registered patient in their practice (regardless of whether they have COVID-19 or not) and an additional EUR 15 per hour for extra out-of-office care services due to the coronavirus. (https://www-medischcontact-nl /nieuws/laatste-nieuws/nieuwsartikel/huisartsen-krijgen-10-euro-opslag-per-patient.htm).
In July 2020, hospitals and insurers finalized their negotiations on how to deal with the extra expenditures due to COVID-19. Hospitals will receive a fixed budget for 2020 based on the originally negotiated turnover for 2020. They receive 100% of fixed costs and 80% of variable costs (assuming that they had 20% less regular care provided due to COVID-19). Extra costs or underspending will be offset against the originally negotiated budget and will be payable if the result exceeds the negotiated budget. Extra expenditure calculations are not based on actual costs, but on a percentage of the negotiated budget plus a higher fee for hospital days and ICU days for COVID-19 patients (https://www.skipr.nl/nieuws/akkoord-ziekenhuizen-en-zn-compensatie-van-alle-coronakosten/).
In December 2020, the umbrella organizations of the Dutch health insurers (Zorgverzekeraars Nederland) and the Dutch hospitals (Nederlandse Vereniging van Ziekenhuizen and Nederlandse Federatie van Universitair Medische Centra) have concluded an agreement on how to proceed with the financial risks for hospitals. These risks include care for COVID-19 patients, postponed regular care and catching up with this postponed care, as well as a large reduction in referrals by GPs (about one million less than ‘normal’). The contracts for 2020 are the basis for 2021, limiting the possibilities for negotiations considerably. For the catch-up of regular care, hospitals and health insurers will make individual agreements. Health insurers will compensate hospitals for operating costs that cannot be covered as a result of postponement of regular care (88% of the cost of non-realized care) as well as extra costs due to COVID-19. Health insurers will also contribute to the costs of having ICU beds available for COVID-19 care (beschikbaarheidsbijdrage). If the national healthcare budget for medical specialist care for 2021 is exceeded (Macrokader Medisch Specialistische Zorg 2021), extra expenditure due to COVID-19 care and catch-up care will be exempted from the obligation to pay back the amount that is exceeded by the hospitals (based on the ‘claw-back’ regulation: macrobeheersinstrument) (https://www.zn.nl/actueel/nieuws/nieuwsbericht?newsitemid=5712347136; https://www.zorgvisie.nl/ziekenhuizen-en-zn-maken-ventiel-in-bkz-2021-voor-inhaalzorg/; https://www.rijksoverheid.nl/documenten/publicaties/2020/12/18/afspraken-vws-nvz-nfu-zn-over-de-financiele-gevolgen-van-de-covid-crisis-in-2021).
In the national budget of the Ministry of Health for 2021, extra budget is reserved for COVID-19 for the following activities in the healthcare sector:
• 300 million for developing and purchasing vaccines
• 94 million of ensuring the availability of hospital beds (both ICU and clinical)
• 100 million for the central organisation of the Public Health Service for facilitating testing, contact tracing and registration
• 9 million of the development of an ICT application that can monitor the situation as real time as possible.
• 21 million for waste water surveillance
• 359 million for the extra expenditure for handling outbreaks for the Public Health Services and the Safety regions (a collaboration of municipalities that are addressing any safety issues in their region)
• Extra bonus for care personnel (500 euro per person, total 720 million euro) (https://www.rijksbegroting.nl/2021/voorbereiding/begroting?hoofdstuk=40.25)